Provider Demographics
NPI:1265977375
Name:MCMILLON, LAUREN (ATC, LAT, CES, ITAT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MCMILLON
Suffix:
Gender:F
Credentials:ATC, LAT, CES, ITAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 GOVERNOR RITCHIE HWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3924
Mailing Address - Country:US
Mailing Address - Phone:443-261-2243
Mailing Address - Fax:410-384-1613
Practice Address - Street 1:580 GOVERNOR RITCHIE HWY
Practice Address - Street 2:SUITE E
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3924
Practice Address - Country:US
Practice Address - Phone:443-261-2243
Practice Address - Fax:410-384-1613
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA000472255A2300X
DEJ3-00004152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer